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This document summarizes a Six Sigma project conducted by Abu Dhabi Police Medical Services from January to June 2012 to improve defects in pre-analytical and post-analytical processes in their medical laboratory. The project aimed to reduce delay in laboratory results, improve patient safety, and increase customer satisfaction by defining, measuring, analyzing, improving, and controlling critical-to-quality factors affecting the significance and delay of laboratory test results. Data was collected over 10 days to analyze factors such as inappropriate test requests, errors in specimen labeling, registration and verification of results, staff training, IT issues, and specimen transport times.

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Abu Dhabi Police Medical Services Six Sigma Project January –June 2012 Project Name & Ref. No. : Defect in Pre-analytical and Post-analytical Process in Medical Laboratory (ADP-SS-05)
CHAMPION: Lt.Col .Jassem Altunaiji Black Belt: Maj.Dr. Ayman Jmai’an Ehab Naji Green Belt: Maj.Thuraya Aldawilah Capt. Saleh Alalbi Eunice Jane Tanagon Hamda Alqubaisi Dr. Subhash Mehta Ameera Alalawi Tahanni
DEFINE : Jan 12th to Jan 30th 2012 MEASURE: Jan 30th to March 22nd 2012 ANALYSE: March 22nd to April 20th 2012 IMPROVE: April 20th to Jun 6th 2012 CONTROL: June 7th to 24th 2012
DEFINE Business Need: IMPROVE PATIENT SAFETY, REDUCE DELAY IN LABORATORY RESULTS, INCREASE CUSTOMER SATISFACTION.
DEFINE CTQs: 1. Delay of Laboratory test results. 2. Significance of Laboratory test results
CTPs: DEFINE 1. SIGNIFICANCE 2. DELAY 1.Inappropriate/incorrect test request 1.Inappropriate/incorrect/irrelevant test request for the patient for the patient 2.Error in specimen labeling 2. Temporary I.T system disruption and inadequacy 3.Error in result registration 3. Manual registration of 4.Multiple result registration patients/employment/training personnel (Demographic & test request) 5.Multiple result verification and 4.Specimen transport validation 5. Inadequate system to relay critical and 6.Staff Training and Experience urgent results to requesting Physician 6. Multiple result registrations 7. Multiple result verification and validation 8. Human Resources (Staff Inadequacy) Laboratory Supplies (Logistics/Inventory)
DEFINE Data Collection Plan : 1. Collect number of Patients/Pre-employment/ Training/ Visa in respect to the CTPs for 10 days including supported previous data from January 10, 2012. 2. Collect number of results not released as per turn-around- time 3. Collect data using Checksheet and Data collection table for: a. Significance of Laboratory test results b. Delay of Laboratory test results.
Pre-Analytical Data Collection sheet
Post Analytical Data Collection sheet
Checksheet
DEFINE Summary For Factors Affecting Significance Of Laboratory Results No. of population per day FACTORS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 DAY 10 PREVIOUS TOTAL AFFECTING 17/1 18/1 19/1 22/1 23/1 24/1 25/1 26/1 29/1 30/1 DATA SIGNIFICANCE OF RESULTS Inappropriate/Incorrect 4 5 4 3 3 2 1 1 2 2 15 42 test request for patient Error in specimen 2 2 2 1 1 1 2 1 2 2 10 26 labeling Error in result 1 1 1 0 0 1 1 1 1 1 2 10 registration Multiple result 1 1 1 1 0 0 0 1 1 1 2 9 registration Multiple result 1 1 1 1 0 0 0 1 1 2 2 10 verification&valid’n Staff Training & 1 1 0 0 1 1 1 1 1 1 2 10 Experience Total Population 384 976
Summary For Factors Causing The Delay Of DEFINE Laboratory Results FACTORS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 DAY 10 PREVIOUS TOTAL 17/1 18/1 19/1 22/1 23/1 24/1 25/1 26/1 29/1 30/1 DATA CAUSING THE DELAY OF RESULTS Inappropriate/incorrect/ irrelevant test request 4 5 4 3 3 2 4 3 4 5 19 56 for the patient Temporary IT system disruption and 9 11 9 7 6 5 8 5 8 10 39 108 inadequacy Manual registration of patients 21 45 21 20 42 9 24 10 19 43 127 381 /employment(data input) Specimen transport 4 5 4 3 3 2 4 3 2 2 16 48 Inadequate system to relay critical and urgent 1 2 2 1 1 1 2 1 2 2 10 25 results to requesting physician Multiple result 48 48 45 39 34 35 58 26 46 64 222 665 registration Multiple result 48 48 45 39 34 35 58 26 verification&valid’n 46 64 222 665 Human Resources (Staff 52 54 50 39 37 36 61 29 49 68 238 713 Inadequacy) Laboratory Supplies (Logistics/Inventory) Total Population 384 976
DEFINE Pareto Chart For Factors Affecting Significance of Laboratory Results 120 100 100 Percent 80 Count 80 60 60 40 40 20 20 0 0 Factor nt g n n e n in t io io nc t io at ie b el ra at ie ra t li d er p la is va ist of en reg ex p re g es t i m l t a nd d lt c qu pe su n an es u re s re io g r t n n at in e es ri ri rif ic in pl t ro ro ra lt i ct Er Er ve f T M u rr e ul t t af o s S nc re /I l e iat e lt ip r u p M p ro a p In Count 42 26 10 10 10 9 Percent 39.3 24.3 9.3 9.3 9.3 8.4 Cum % 39.3 63.6 72.9 82.2 91.6 100.0
DEFINE Pareto Chart For Factors Causing the Delay of Laboratory Results 2500 100 2000 80 Count Percent 1500 60 1000 40 500 20 0 0 Factor ) n n ) er ry io ti o ut a cy to at np th tr a i qu O en s al id a de nv gi v at a /I re d (d in s ul t an nt d ti c n e an is res io m n Lo g e at oy pt io pl ifi c pl s( lt i m ru li e u v er /e di s pp M t ts IT Su ul n es ie y or y r at ar at pl e p or r lt i of p bo u n Te m La M tio y) ra c st ua eg i deq lr na ua f fi an ta M (S es rc s ou re an um H Count 713 665 665 301 108 129 Percent 27.6 25.8 25.8 11.7 4.2 5.0 Cum % 27.6 53.4 79.2 90.8 95.0 100.0
DEFINE Problems related to the CTQs (Significance and Delay of the results) after Brainstorming and Pareto Charts analysis are : 1. Multiple result registration 2. Multiple result verification and validation 3. Inappropriate/ Incorrect test request for patients 4. Human Resources (Staff Inadequacy) Laboratory Supplies (Logistics and Inventory) 5. Error in specimen labelling
The Problem statement: DEFINE 11% of released laboratory results form January 10-3- 2012 contain more that 8 errors in average per day 45% of patients results and 100% of pre-employment and visa result from January 10-30, 2012 exceeded target turn-around-time. The Goal statement: 1. Reduce the errors from 11% to 8% within 6 months. 2. Reduce delayed patients result from 45% to 30% within 6 months 3. Reduce delayed pre-employments and visa test results from 100% to 80%within 6 months.
DEFINE Overview Process Map: 1. SIRPORC 2. Flow Chart
DEFINE Improvement Expected from the Project: 1. Error-free results. 2. On-time results 3. Patients, Physicians, and Laboratory employee Satisfaction 4. Cost saving
Data Collection Plan MEASURE • Collect number of Patients/Pre-employment/Training/Visa in respect to the CTPs from May 30,31 – June 3,4, 2012 • Collect number of results not released as per turn-around- time. • Collect data using Check sheet and Data collection table for time taken to complete each sub-process of pre and post analytical phases
MEASURE Average time Patient and Pre-employment to complete Pre- Analytical process 60 50 49.06 Time (minutes) 40 38.07 30 20 10 0 Patient Pre-employment/Training/Visa Renewal
MEASURE Pre-Analytical Process Subfractions 30 27 25 20 19.32 Time (minutes) 17.5 15 14.26 Patient 10 Pre- employment/Training/Vi sa Renewal 5 4.49 4.57 0 Time taken to complete Waiting Time Sample transport time process in reception
MEASURE Average Number of Patients and Pre-employment/Training/Visa renewal personnel as per time slot 30 25 24 Number of Customers 20 19 PATIENTS 15 14 14 PRE- 11 EMPLOYMENT/TRAINING/ 10 9 VISA RENEWAL 6 5 5 5 4 4 2 0 7:30-8:30 8:31-9:30 9:31-10:30 10:31-11:30 11:31-12:30 12:31-1:30 Time slot
MEASURE Average Time Taken For Biochem&Haem POST ANALYTICAL PROCESS 120 100 Time /min 80 72.8 60 BIO Post-analytical process 40.4 CBC Post-analytical process 40 20 35.3 52.8 0 PATIENTS PRE-EMPL./TRAINING/VISA RENUAL
MEASURE PATIENTS POST ANALYTICAL PROCESS SUB FRACTIONS 30 26.9 25 20 Time /min 15 14.4 13.5 10 10.9 10 5 0 time from printed time from enter CBC time from IT entery time from printing time from IT entery CBC result to logbook entery of CBC results to BIO result to IT of BIO resluts to logbook entery untill IT entery time of validation entery time of validation
PRE-EMP/TRANING POST ANALYTICAL PROCESS MEASURE SUB FRACTIONS 500 442 450 400 350 298 300 Time / min 250 227 200 200 157 150 100 47.2 50 35.7 25.6 17.1 0 time from time from time from time from time from time from time from time from time from printed CBC printing BIO result form result was IT entery validation logbook CBC result logbook BIO result logbook entery signed untill result untill entery to logbook entery to to logbook entery to untill untill IT validated release untill result entery result form enetry result form pathologist entery logbook released entery entery signature entery
MEASURE Time taken to complete process of releasing Pre-emp. Result to Medical Check Section 1400 1324 1200 TIME per minutes 1000 800 600 442 400 298 227 200 200 157 0 time from result time from result time from IT time from time from total time form entery was signed entery untill validation untill logbook entery untill signed by untill IT entery result validated release logbook untill result pathologist entery received by Medical Check Unit
MEASURE SIGNIFICANCE OF RESULTS Significance of Laboratory Test results Critical to Quality (CTQ): Defects:107 Unit: 976 Opportunity of Errors: 6 107/976 Defects per unit (DPU): 107 x 106 Defects per Million Opportunities (DPMO): 976 6 DPMO = 18,272 SIGMA LEVEL: 3.59
MEASURE PRE-ANALYTICAL PROCESSES FOR PATIENTS Delay in Pre-analytical Processes Critical to Quality (CTQ): CTQ Measure: Number of delays occurred Defects: Delays PROCESS TURN-AROUND- DPMO SIGMA LEVEL TIME (minutes) Opportunity for error:1 Time taken to 3 minutes Defects: 41 1.81 complete process Units: 108 in reception DPMO: 379,630 Sampling Time 12 minutes Defects : 56 1.45 Units: 108 DPMO: 518,519 Sample Transport 5 minutes Defects: 72 1.07 time Units: 88 DPMO: 666,667
MEASURE PRE-ANALYTICAL PROCESSES FOR PRE- EMPLOYMENT/ TRAINING/ VISA RENEWAL Delay in Pre-analytical Processes Critical to Quality (CTQ): CTQ Measure: Number of delays occurred Defects: Delay PROCESS TURN-AROUND- DPMO SIGMA LEVEL TIME (minutes) Opportunity for error:1 Time taken to 3 minutes Defects: 126 1.48 complete process in Units: 249 reception DPMO: 506024 Sampling Time 12 minutes Defects : 199 0.66 Units: 249 DPMO:799197 Sample Transport 5 minutes Defects: 179 0.58 time Units: 218 DPMO: 821101
MEASURE POST-ANALYTICAL PROCESSES FOR PATIENTS PROCESS TURN-AROUND- DPMO SIGMA LEVEL TIME (minutes) Opportunity for error:1 CBC Time taken from printed 5 minutes Defects: 28 1.15 result to logbook Units: 44 registration DPMO: 636,364 Time taken from logbook 10 minutes Defects : 14 1.95 entry to IT entry Units: 43 DPMO: 325,581 Time taken from IT entry 10 minutes Defects: 8 2.39 to time of validation Units: 43 DPMO: 186,047 BIOCHEMISTRY Time taken from printing 15 minutes Defects : 37 1.53 the result to IT entry Units: 76 DPMO: 486,842 Time taken from IT entry 10 minutes Defects: 21 2.09 to time of validation Units: 76 DPMO: 276,316
MEASURE POST-ANALYTICAL PROCESSES FOR PRE-EMPLOYMENT/ TRAINING/ VISA RENEWAL PROCESS TURN-AROUND-TIME DPMO SIGMA LEVEL (minutes) Opportunity for error:1 CBC Time from printed 5 minutes Defects : 111 0.7 result to logbook Units: 141 registration DPMO: 787,234 Time from enter result 5 minutes Defects: 199 0.4 in logbook to enter it in Units: 205 result form DPMO: 970,732
POST-ANALYTICAL PROCESSES FOR PRE- MEASURE EMPLOYMENT/ TRAINING/ VISA RENEWAL BIOCHEMISTRY Time from printed 5 minutes Defects : 107 0.4 result to logbook Units: 108 registration DPMO: 990,741 Time from logbook 5 minutes Defects: 201 0.4 entry to result form Units: 204 entry DPMO: 985,294 Time from result from 60 minutes Defects: 248 0.4 entry until pathologist Units: 248 signature DPMO:985,294 Time from result was 60 minutes Defects: 248 0.4 signed until IT entry Units:248 DPMO:985,294 Time from IT entry until 60 minutes Defects: 248 0.4 result validated Units:248 DPMO:985,294 Time from validation 60 minutes Defects: 248 0.4 until logbook entry Units:248 DPMO:985,294 Time from logbook 60 minutes Defects: 248 0.4 entry until result release Units:248
ANALYSE FISHBONE DIAGRAM FOR THE PRE-ANALYTICAL AND POST- ANALYTICAL PROCESS IN THE MEDICAL LABORATORY
IMPROVE BREAKTHROUGH improvement actions has been taken after calculating RPN of each sub-process, Actions include: 1. Post permanent and trained receptionist 2. All request will be made through IT system (barcoding) 3. Appointment system for pre-emp/Training/ Visa renewal 4. Modify IT system for ICDs/RCOs for physicians in ordering of test repetitions and tests added after tests has been ordered 5. Eliminate entry of results in the logbooks 6. Hire porter for transporting the samples
Breakthrough Improvement Actions IMPROVE PLAN A Actions Constraints PLAN B Completion Date Permanent New porter appointed - - 10th April porter for the samples PLAN A Actions Constraints PLAN B Completio n Date Eliminate Clarification letter Waiting for - 28th May entry on log from HAAD to approve the system to book in the action (received be activated reception and on 19th April) lab. sections
Breakthrough Improvement Actions IMPROVE PLAN A Actions Constraints PLAN B Completion Date Hire Request the hiring Refused ! Post a qualified 16/5/2012 permanent of medical non-medical and trained receptionist receptionist from other receptionist from Human department to Resource the lab Administration
Breakthrough Improvement Actions IMPROVE PLAN A Actions Constraints PLAN B Completion Date Appointment IT Meetings and No consensus Manual 14/6/2012 system for pre- requests have been appointm employments done with ent and trainings concerned system tests departments
Breakthrough Improvement Actions IMPROVE PLAN A Actions Constraints PLAN B Completion Date 1. LIS 1. Reviewed Out of 2012 Modifications 28th MAY* 2. Interface the budget and quotations in current IT barcodes and offers Long process system and 3. Interface to install 2. Meeting (over 8 barcoding with IT months) department
IMPROVE 1. Installation of Barcode readers 2. Installation of New printers 3. Installation of Slip printer 4. 2 work station in phlebotomy units 5. Modifications on lab reception and phlebotomy unit IT system 6. Activate Medical Check IT System 7. Installation of photo-capturing devices 8. Train lab staff and Medical Check Unit on the new modifications
Finalized
Finalized
Data Collection Plan IMPROVE • Collect number of Patients/Pre-employment/Training/Visa in respect to the CTPs . • Collect data using Check sheet and Data collection table for time taken to complete each sub-process of pre and post analytical phases
IMPROVE Average time Patient and Pre-employment to complete Pre-analytical process 50 45 47 40 35 Time per minute 36 35 30 25 before 25 20 after 15 10 5 0 patient pre-employment
IMPROVE Time taken to complete PATIENT post- analytical process 80 70 60 50 Time per minutes 40 71.8 30 54.6 20 10 0 post process BEFORE post process NOW
IMPROVE Time taken to complete PRE- EMPLOYMENT post process 1600 1400 1200 Time per minutes 1000 800 1432.4 600 400 200 200 0 post process BEFORE post process NOW
DATA for VALIDATION of Improvement actions : IMPROVE Process Without the use of color code by Use of color code by the porter the porter Patients Pre-Employment Patient Pre-Employment Sample SD – 6.7 SD- 7.05 SD- 4.66 SD- 5.92 Transport time Mean- 12.06 Mean- 10.24 Mean- 9.46 Mean- 9.95 RSD -55% RSD-68.84% RSD-49.2% RSD – 59.49% Work handled by the previous Work handled by the other phlebotomist phlebotomist w/ the appointment system Patients Pre-Employment Patients Pre-employment Sampling Time SD- 11.5 SD- 25.31 SD- 6.69 SD-8.0 Mean- 18 Mean – 33.35 Mean- 14.85 Mean 15.8 RSD- 63.8% RSD- 75.89% RSD- 45% RSD- 50.6%
IMPROVE SIGNIFICANCE OF RESULTS: BEFORE AFTER DPMO = 18,272 DPMO = 2,554 SIGMA LEVEL: 3.59 SIGMA LEVEL: 4.3
IMPROVE PRE-ANALYTICAL PROCESSES FOR PATIENTS Critical to Quality (CTQ): Delay in Pre-analytical Processes CTQ Measure: Number of delays occurred Defects: Delays PROCESS TURN- DPMO SIGMA DPMO SIGMA AROUND- Opportunity for LEVEL Opportunity for LEVEL TIME error:1 BEFORE error:1 AFTER (minutes) Time taken to 3 minutes Defects: 41 1.81 Defects: 11 2.76 complete process Units: 108 Units: 106 in reception DPMO: 379,630 DPMO: 103,774 Sampling Time 12 minutes Defects : 56 1.45 Defects : 26 1.59 Units: 108 Units: 56 DPMO: 518,519 DPMO: 464,286 Sample Transport 10 minutes Defects: 72 0.59 Defects:17 2.01 time Units: 88 Units: 56 DPMO: 818,182 DPMO: 303,571
IMPROVE PRE-ANALYTICAL PROCESSES FOR PRE-EMPLOYMENT/ TRAINING/ VISA RENEWAL Critical to Quality (CTQ): Delay in Pre-analytical Processes CTQ Measure: Number of delays occurred Defects: Delay PROCESS TURN- DPMO SIGMA LEVEL DPMO SIGMA AROUND-TIME Opportunity for BEFORE Opportunity for LEVEL (minutes) error:1 error:1 AFTER Time taken to 3 minutes Defects: 126 1.48 Defects: 16 2.76 complete process Units: 249 Units:155 in reception DPMO: 506024 DPMO: 103,226 Sampling Time 12 minutes Defects : 199 0.66 Defects : 51 1.21 Units: 249 Units: 83 DPMO:799197 DPMO:614,458 Sample Transport 10 minutes Defects: 179 0.58 Defects: 34 1.73 time Units: 218 Units: 83 DPMO: 821101 DPMO: 409,638
IMPROVE POST-ANALYTICAL PROCESSES FOR PATIENTS PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND-TIME Opportunity LEVEL Opportunity for error:1 AFTER (minutes) for error:1 BEFORE CBC Time taken from 5 minutes Defects: 28 1.15 Defects: PROCESS printed result to Units: 44 Units: ELIMINATED logbook registration DPMO: DPMO: 636,364 Time taken from 10 minutes Defects : 14 1.95 Defects : PROCESS logbook entry to IT Units: 43 Units: ELIMINATED entry DPMO: DPMO: 325,581 Time taken from 10 minutes Defects: 29 1.27 printing the result to Units: 49 IT entry DPMO: 591837 Time taken from IT 10 minutes Defects: 8 2.39 Defects: 9 2.4 entry to time of Units: 43 Units: 49 validation DPMO: DPMO: 186,047 183,673
IMPROVE POST-ANALYTICAL PROCESSES FOR PATIENTS PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND-TIME Opportunity LEVEL Opportunity for error:1 AFTER (minutes) for error:1 BEFORE BIOCHEMISTRY Time taken from 15 minutes Defects : 37 1.53 Defects : 25 1.67 printing the result to Units: 76 Units: 58 IT entry DPMO: DPMO: 431034 486,842 Time taken from IT 10 minutes Defects: 21 2.09 Defects: 14 2.2 entry to time of Units: 76 Units: 58 validation DPMO: DPMO: 241379 276,316
POST-ANALYTICAL PROCESSES FOR PRE- IMPROVE EMPLOYMENT/ TRAINING/ VISA RENEWAL Critical to Quality (CTQ): Delay in Post-analytical Processes CTQ Measure: Number of delays occurred Defects: Delay PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND- Opportunity for LEVEL Opportunity for AFTER TIME error:1 BEFORE error:1 (minutes) CBC Time from 5 minutes Defects : 111 0.7 Defects : PROCESS printed result to Units: 141 Units: ELIMINATED logbook DPMO: 787,234 DPMO: registration Time from enter 5 minutes Defects: 199 0.4 Defects: PROCESS result in logbook Units: 205 Units: ELIMINATED to enter it in DPMO: 970,732 DPMO: result form Time from printed 60 minutes Defects:1 3.81 result to IT Units:96 registration DPMO: 10417 Time from IT 60 minutes Defects:10 2.76 entry until result Units:96 validated DPMO: 104167
POST-ANALYTICAL PROCESSES FOR PRE- IMPROVE EMPLOYMENT/ TRAINING/ VISA RENEWAL PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND- Opportunity for LEVEL Opportunity for AFTER TIME error:1 BEFORE error:1 (minutes) BIOCHEMISTRY Time from printed 5 minutes Defects : 107 0.4 Defects : PROCESS ELIMINATED result to logbook Units: 108 Units: registration DPMO: 990,741 DPMO: Time from logbook 5 minutes Defects: 201 0.4 Defects: PROCESS ELIMINATED entry to result Units: 204 Units: form entry DPMO: 985,294 DPMO: Time from result 60 minutes Defects: 248 0.4 Defects: PROCESS ELIMINATED from entry until Units: 248 Units: pathologist DPMO:985,294 DPMO: signature
POST-ANALYTICAL PROCESSES FOR PRE- IMPROVE EMPLOYMENT/ TRAINING/ VISA RENEWAL PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND- Opportunity for LEVEL Opportunity for AFTER TIME error:1 BEFORE error:1 (minutes) Time from result 60 minutes Defects: 248 0.4 Defects: PROCESS was signed until IT Units:248 Units: ELIMINATED* entry DPMO:985,294 DPMO: Time from printed 60 minutes Defects:10 2.72 result to IT Units:90 registration DPMO: 111111 Time from IT entry 60 minutes Defects: 248 0.4 Defects: 4 3.2 until result Units:248 Units:90 validated DPMO:985,294 DPMO: 44444 Time from 60 minutes Defects: 248 0.4 Defects: PROCESS ELIMINATED validation until Units:248 Units: logbook entry DPMO:985,294 DPMO: Time from logbook 60 minutes Defects: 248 0.4 Defects: PROCESS entry until result Units:248 Units: ELIMINATED release DPMO: 985,294 DPMO:
IMPROVE The Goal statement: 1. Reduce the errors from 11% to 8% within 6 months. 2. Reduce delayed patients result from 45% to 30% within 6 months 3. Reduce delayed pre-employments and visa test results from 100% to 80%within 6 months. Achievement after IMPROVE 1. Errors reduced from 11% to 1.5% . 2. Delayed patients results reduced from 45% to 14% . 3. Delayed pre-employments and visa test results from 100% to 35%
IMPROVE Before Expected After improve improve Errors 11% 8% 1.5% Patient 45% 30% 14.5% delayed results Pre-empl. 100% 80% 35% Delayed results
IMPROVE Saved Cost: Unnecessary Requests • 5,512 tests / year Cost: 49,181 AED Rework • 1040 tests / year Cost: 9,279 AED Medical Laboratory Technician • 156 hours/ year wasted time to do the unnecessary requests, rework • Cost: 172,192 AED Office boy wasted time for delivery of Pre- • 52 hours/ year employment/Training results in the Medical Check Section • Cost: 6,171 AED TOTAL SAVINGS: 236,823 AED / YEAR
CONTROL GUIDELINES, ASSINGNED RESPONSIPILITY, and COMMUNICATION:  Staff orientation on the New Standard Operating procedure  Daily check for IT performance  Check performance, scheduled calibration and PMs for barcode readers and photo-capturing devices.  Daily check for attendance of receptionists and porter  Monthly Control charts  Monthly reports to Champion  Review of Control charts and do corrective actions if required
P Chart of Patients Sampling Time CONTROL 0.30 UCL=0.2720 0.25 0.20 Proportion 0.15 0.10 _ P=0.0894 0.05 0.00 LCL=0 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sampling Dates P Chart of Pre-employment Sampling Time 0.5 UCL=0.4401 0.4 0.3 Proportion _ 0.2 P=0.2123 0.1 0.0 LCL=0 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sampling Dates
Xbar-R Chart of Patients Sampling Time CONTROL 14 U C L=14.018 13 Sample Mean _ _ 12 X=11.8 11 10 LC L=9.582 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s U C L=16.43 15.0 Sample Range 12.5 _ 10.0 R=9.94 7.5 5.0 LC L=3.45 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s Xbar-R Chart of Pre-Employment Sampling Time U C L=16.164 16 Sample Mean 15 _ _ X=14.444 14 13 LC L=12.725 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s U C L=12.74 12 Sample Range 10 _ 8 R=7.71 6 4 LC L=2.67 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s
P Chart of Patients CBC Validation time CONTROL 0.35 UCL=0.3167 0.30 0.25 Proportion 0.20 0.15 _ 0.10 P=0.1024 0.05 0.00 LCL=0 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sampling Dates P Chart of Patients Biochemistry Validation 0.30 UCL=0.2910 0.25 0.20 Proportion 0.15 _ 0.10 P=0.0971 0.05 0.00 LCL=0 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sampling Dates
Xbar-R Chart of Patients Biochemistry Validation Time CONTROL 8 U C L=8.111 7 Sample Mean _ _ 6 X=5.8 5 4 LC L=3.489 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s U C L=17.13 15 Sample Range _ 10 R=10.36 5 LC L=3.59 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s Xbar-R Chart of Patients CBC Validation Time 1 10 U C L=9.745 Sample Mean 8 _ _ 6 X=6.189 4 LC L=2.633 2 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s 1 30 U C L=26.35 Sample Range 20 _ R=15.94 10 LC L=5.52 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s
Finalized
Finalized
Finalized
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Finalized

  • 1. Abu Dhabi Police Medical Services Six Sigma Project January –June 2012 Project Name & Ref. No. : Defect in Pre-analytical and Post-analytical Process in Medical Laboratory (ADP-SS-05)
  • 2. CHAMPION: Lt.Col .Jassem Altunaiji Black Belt: Maj.Dr. Ayman Jmai’an Ehab Naji Green Belt: Maj.Thuraya Aldawilah Capt. Saleh Alalbi Eunice Jane Tanagon Hamda Alqubaisi Dr. Subhash Mehta Ameera Alalawi Tahanni
  • 3. DEFINE : Jan 12th to Jan 30th 2012 MEASURE: Jan 30th to March 22nd 2012 ANALYSE: March 22nd to April 20th 2012 IMPROVE: April 20th to Jun 6th 2012 CONTROL: June 7th to 24th 2012
  • 4. DEFINE Business Need: IMPROVE PATIENT SAFETY, REDUCE DELAY IN LABORATORY RESULTS, INCREASE CUSTOMER SATISFACTION.
  • 5. DEFINE CTQs: 1. Delay of Laboratory test results. 2. Significance of Laboratory test results
  • 6. CTPs: DEFINE 1. SIGNIFICANCE 2. DELAY 1.Inappropriate/incorrect test request 1.Inappropriate/incorrect/irrelevant test request for the patient for the patient 2.Error in specimen labeling 2. Temporary I.T system disruption and inadequacy 3.Error in result registration 3. Manual registration of 4.Multiple result registration patients/employment/training personnel (Demographic & test request) 5.Multiple result verification and 4.Specimen transport validation 5. Inadequate system to relay critical and 6.Staff Training and Experience urgent results to requesting Physician 6. Multiple result registrations 7. Multiple result verification and validation 8. Human Resources (Staff Inadequacy) Laboratory Supplies (Logistics/Inventory)
  • 7. DEFINE Data Collection Plan : 1. Collect number of Patients/Pre-employment/ Training/ Visa in respect to the CTPs for 10 days including supported previous data from January 10, 2012. 2. Collect number of results not released as per turn-around- time 3. Collect data using Checksheet and Data collection table for: a. Significance of Laboratory test results b. Delay of Laboratory test results.
  • 9. Post Analytical Data Collection sheet
  • 11. DEFINE Summary For Factors Affecting Significance Of Laboratory Results No. of population per day FACTORS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 DAY 10 PREVIOUS TOTAL AFFECTING 17/1 18/1 19/1 22/1 23/1 24/1 25/1 26/1 29/1 30/1 DATA SIGNIFICANCE OF RESULTS Inappropriate/Incorrect 4 5 4 3 3 2 1 1 2 2 15 42 test request for patient Error in specimen 2 2 2 1 1 1 2 1 2 2 10 26 labeling Error in result 1 1 1 0 0 1 1 1 1 1 2 10 registration Multiple result 1 1 1 1 0 0 0 1 1 1 2 9 registration Multiple result 1 1 1 1 0 0 0 1 1 2 2 10 verification&valid’n Staff Training & 1 1 0 0 1 1 1 1 1 1 2 10 Experience Total Population 384 976
  • 12. Summary For Factors Causing The Delay Of DEFINE Laboratory Results FACTORS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 DAY 10 PREVIOUS TOTAL 17/1 18/1 19/1 22/1 23/1 24/1 25/1 26/1 29/1 30/1 DATA CAUSING THE DELAY OF RESULTS Inappropriate/incorrect/ irrelevant test request 4 5 4 3 3 2 4 3 4 5 19 56 for the patient Temporary IT system disruption and 9 11 9 7 6 5 8 5 8 10 39 108 inadequacy Manual registration of patients 21 45 21 20 42 9 24 10 19 43 127 381 /employment(data input) Specimen transport 4 5 4 3 3 2 4 3 2 2 16 48 Inadequate system to relay critical and urgent 1 2 2 1 1 1 2 1 2 2 10 25 results to requesting physician Multiple result 48 48 45 39 34 35 58 26 46 64 222 665 registration Multiple result 48 48 45 39 34 35 58 26 verification&valid’n 46 64 222 665 Human Resources (Staff 52 54 50 39 37 36 61 29 49 68 238 713 Inadequacy) Laboratory Supplies (Logistics/Inventory) Total Population 384 976
  • 13. DEFINE Pareto Chart For Factors Affecting Significance of Laboratory Results 120 100 100 Percent 80 Count 80 60 60 40 40 20 20 0 0 Factor nt g n n e n in t io io nc t io at ie b el ra at ie ra t li d er p la is va ist of en reg ex p re g es t i m l t a nd d lt c qu pe su n an es u re s re io g r t n n at in e es ri ri rif ic in pl t ro ro ra lt i ct Er Er ve f T M u rr e ul t t af o s S nc re /I l e iat e lt ip r u p M p ro a p In Count 42 26 10 10 10 9 Percent 39.3 24.3 9.3 9.3 9.3 8.4 Cum % 39.3 63.6 72.9 82.2 91.6 100.0
  • 14. DEFINE Pareto Chart For Factors Causing the Delay of Laboratory Results 2500 100 2000 80 Count Percent 1500 60 1000 40 500 20 0 0 Factor ) n n ) er ry io ti o ut a cy to at np th tr a i qu O en s al id a de nv gi v at a /I re d (d in s ul t an nt d ti c n e an is res io m n Lo g e at oy pt io pl ifi c pl s( lt i m ru li e u v er /e di s pp M t ts IT Su ul n es ie y or y r at ar at pl e p or r lt i of p bo u n Te m La M tio y) ra c st ua eg i deq lr na ua f fi an ta M (S es rc s ou re an um H Count 713 665 665 301 108 129 Percent 27.6 25.8 25.8 11.7 4.2 5.0 Cum % 27.6 53.4 79.2 90.8 95.0 100.0
  • 15. DEFINE Problems related to the CTQs (Significance and Delay of the results) after Brainstorming and Pareto Charts analysis are : 1. Multiple result registration 2. Multiple result verification and validation 3. Inappropriate/ Incorrect test request for patients 4. Human Resources (Staff Inadequacy) Laboratory Supplies (Logistics and Inventory) 5. Error in specimen labelling
  • 16. The Problem statement: DEFINE 11% of released laboratory results form January 10-3- 2012 contain more that 8 errors in average per day 45% of patients results and 100% of pre-employment and visa result from January 10-30, 2012 exceeded target turn-around-time. The Goal statement: 1. Reduce the errors from 11% to 8% within 6 months. 2. Reduce delayed patients result from 45% to 30% within 6 months 3. Reduce delayed pre-employments and visa test results from 100% to 80%within 6 months.
  • 17. DEFINE Overview Process Map: 1. SIRPORC 2. Flow Chart
  • 18. DEFINE Improvement Expected from the Project: 1. Error-free results. 2. On-time results 3. Patients, Physicians, and Laboratory employee Satisfaction 4. Cost saving
  • 19. Data Collection Plan MEASURE • Collect number of Patients/Pre-employment/Training/Visa in respect to the CTPs from May 30,31 – June 3,4, 2012 • Collect number of results not released as per turn-around- time. • Collect data using Check sheet and Data collection table for time taken to complete each sub-process of pre and post analytical phases
  • 20. MEASURE Average time Patient and Pre-employment to complete Pre- Analytical process 60 50 49.06 Time (minutes) 40 38.07 30 20 10 0 Patient Pre-employment/Training/Visa Renewal
  • 21. MEASURE Pre-Analytical Process Subfractions 30 27 25 20 19.32 Time (minutes) 17.5 15 14.26 Patient 10 Pre- employment/Training/Vi sa Renewal 5 4.49 4.57 0 Time taken to complete Waiting Time Sample transport time process in reception
  • 22. MEASURE Average Number of Patients and Pre-employment/Training/Visa renewal personnel as per time slot 30 25 24 Number of Customers 20 19 PATIENTS 15 14 14 PRE- 11 EMPLOYMENT/TRAINING/ 10 9 VISA RENEWAL 6 5 5 5 4 4 2 0 7:30-8:30 8:31-9:30 9:31-10:30 10:31-11:30 11:31-12:30 12:31-1:30 Time slot
  • 23. MEASURE Average Time Taken For Biochem&Haem POST ANALYTICAL PROCESS 120 100 Time /min 80 72.8 60 BIO Post-analytical process 40.4 CBC Post-analytical process 40 20 35.3 52.8 0 PATIENTS PRE-EMPL./TRAINING/VISA RENUAL
  • 24. MEASURE PATIENTS POST ANALYTICAL PROCESS SUB FRACTIONS 30 26.9 25 20 Time /min 15 14.4 13.5 10 10.9 10 5 0 time from printed time from enter CBC time from IT entery time from printing time from IT entery CBC result to logbook entery of CBC results to BIO result to IT of BIO resluts to logbook entery untill IT entery time of validation entery time of validation
  • 25. PRE-EMP/TRANING POST ANALYTICAL PROCESS MEASURE SUB FRACTIONS 500 442 450 400 350 298 300 Time / min 250 227 200 200 157 150 100 47.2 50 35.7 25.6 17.1 0 time from time from time from time from time from time from time from time from time from printed CBC printing BIO result form result was IT entery validation logbook CBC result logbook BIO result logbook entery signed untill result untill entery to logbook entery to to logbook entery to untill untill IT validated release untill result entery result form enetry result form pathologist entery logbook released entery entery signature entery
  • 26. MEASURE Time taken to complete process of releasing Pre-emp. Result to Medical Check Section 1400 1324 1200 TIME per minutes 1000 800 600 442 400 298 227 200 200 157 0 time from result time from result time from IT time from time from total time form entery was signed entery untill validation untill logbook entery untill signed by untill IT entery result validated release logbook untill result pathologist entery received by Medical Check Unit
  • 27. MEASURE SIGNIFICANCE OF RESULTS Significance of Laboratory Test results Critical to Quality (CTQ): Defects:107 Unit: 976 Opportunity of Errors: 6 107/976 Defects per unit (DPU): 107 x 106 Defects per Million Opportunities (DPMO): 976 6 DPMO = 18,272 SIGMA LEVEL: 3.59
  • 28. MEASURE PRE-ANALYTICAL PROCESSES FOR PATIENTS Delay in Pre-analytical Processes Critical to Quality (CTQ): CTQ Measure: Number of delays occurred Defects: Delays PROCESS TURN-AROUND- DPMO SIGMA LEVEL TIME (minutes) Opportunity for error:1 Time taken to 3 minutes Defects: 41 1.81 complete process Units: 108 in reception DPMO: 379,630 Sampling Time 12 minutes Defects : 56 1.45 Units: 108 DPMO: 518,519 Sample Transport 5 minutes Defects: 72 1.07 time Units: 88 DPMO: 666,667
  • 29. MEASURE PRE-ANALYTICAL PROCESSES FOR PRE- EMPLOYMENT/ TRAINING/ VISA RENEWAL Delay in Pre-analytical Processes Critical to Quality (CTQ): CTQ Measure: Number of delays occurred Defects: Delay PROCESS TURN-AROUND- DPMO SIGMA LEVEL TIME (minutes) Opportunity for error:1 Time taken to 3 minutes Defects: 126 1.48 complete process in Units: 249 reception DPMO: 506024 Sampling Time 12 minutes Defects : 199 0.66 Units: 249 DPMO:799197 Sample Transport 5 minutes Defects: 179 0.58 time Units: 218 DPMO: 821101
  • 30. MEASURE POST-ANALYTICAL PROCESSES FOR PATIENTS PROCESS TURN-AROUND- DPMO SIGMA LEVEL TIME (minutes) Opportunity for error:1 CBC Time taken from printed 5 minutes Defects: 28 1.15 result to logbook Units: 44 registration DPMO: 636,364 Time taken from logbook 10 minutes Defects : 14 1.95 entry to IT entry Units: 43 DPMO: 325,581 Time taken from IT entry 10 minutes Defects: 8 2.39 to time of validation Units: 43 DPMO: 186,047 BIOCHEMISTRY Time taken from printing 15 minutes Defects : 37 1.53 the result to IT entry Units: 76 DPMO: 486,842 Time taken from IT entry 10 minutes Defects: 21 2.09 to time of validation Units: 76 DPMO: 276,316
  • 31. MEASURE POST-ANALYTICAL PROCESSES FOR PRE-EMPLOYMENT/ TRAINING/ VISA RENEWAL PROCESS TURN-AROUND-TIME DPMO SIGMA LEVEL (minutes) Opportunity for error:1 CBC Time from printed 5 minutes Defects : 111 0.7 result to logbook Units: 141 registration DPMO: 787,234 Time from enter result 5 minutes Defects: 199 0.4 in logbook to enter it in Units: 205 result form DPMO: 970,732
  • 32. POST-ANALYTICAL PROCESSES FOR PRE- MEASURE EMPLOYMENT/ TRAINING/ VISA RENEWAL BIOCHEMISTRY Time from printed 5 minutes Defects : 107 0.4 result to logbook Units: 108 registration DPMO: 990,741 Time from logbook 5 minutes Defects: 201 0.4 entry to result form Units: 204 entry DPMO: 985,294 Time from result from 60 minutes Defects: 248 0.4 entry until pathologist Units: 248 signature DPMO:985,294 Time from result was 60 minutes Defects: 248 0.4 signed until IT entry Units:248 DPMO:985,294 Time from IT entry until 60 minutes Defects: 248 0.4 result validated Units:248 DPMO:985,294 Time from validation 60 minutes Defects: 248 0.4 until logbook entry Units:248 DPMO:985,294 Time from logbook 60 minutes Defects: 248 0.4 entry until result release Units:248
  • 33. ANALYSE FISHBONE DIAGRAM FOR THE PRE-ANALYTICAL AND POST- ANALYTICAL PROCESS IN THE MEDICAL LABORATORY
  • 34. IMPROVE BREAKTHROUGH improvement actions has been taken after calculating RPN of each sub-process, Actions include: 1. Post permanent and trained receptionist 2. All request will be made through IT system (barcoding) 3. Appointment system for pre-emp/Training/ Visa renewal 4. Modify IT system for ICDs/RCOs for physicians in ordering of test repetitions and tests added after tests has been ordered 5. Eliminate entry of results in the logbooks 6. Hire porter for transporting the samples
  • 35. Breakthrough Improvement Actions IMPROVE PLAN A Actions Constraints PLAN B Completion Date Permanent New porter appointed - - 10th April porter for the samples PLAN A Actions Constraints PLAN B Completio n Date Eliminate Clarification letter Waiting for - 28th May entry on log from HAAD to approve the system to book in the action (received be activated reception and on 19th April) lab. sections
  • 36. Breakthrough Improvement Actions IMPROVE PLAN A Actions Constraints PLAN B Completion Date Hire Request the hiring Refused ! Post a qualified 16/5/2012 permanent of medical non-medical and trained receptionist receptionist from other receptionist from Human department to Resource the lab Administration
  • 37. Breakthrough Improvement Actions IMPROVE PLAN A Actions Constraints PLAN B Completion Date Appointment IT Meetings and No consensus Manual 14/6/2012 system for pre- requests have been appointm employments done with ent and trainings concerned system tests departments
  • 38. Breakthrough Improvement Actions IMPROVE PLAN A Actions Constraints PLAN B Completion Date 1. LIS 1. Reviewed Out of 2012 Modifications 28th MAY* 2. Interface the budget and quotations in current IT barcodes and offers Long process system and 3. Interface to install 2. Meeting (over 8 barcoding with IT months) department
  • 39. IMPROVE 1. Installation of Barcode readers 2. Installation of New printers 3. Installation of Slip printer 4. 2 work station in phlebotomy units 5. Modifications on lab reception and phlebotomy unit IT system 6. Activate Medical Check IT System 7. Installation of photo-capturing devices 8. Train lab staff and Medical Check Unit on the new modifications
  • 42. Data Collection Plan IMPROVE • Collect number of Patients/Pre-employment/Training/Visa in respect to the CTPs . • Collect data using Check sheet and Data collection table for time taken to complete each sub-process of pre and post analytical phases
  • 43. IMPROVE Average time Patient and Pre-employment to complete Pre-analytical process 50 45 47 40 35 Time per minute 36 35 30 25 before 25 20 after 15 10 5 0 patient pre-employment
  • 44. IMPROVE Time taken to complete PATIENT post- analytical process 80 70 60 50 Time per minutes 40 71.8 30 54.6 20 10 0 post process BEFORE post process NOW
  • 45. IMPROVE Time taken to complete PRE- EMPLOYMENT post process 1600 1400 1200 Time per minutes 1000 800 1432.4 600 400 200 200 0 post process BEFORE post process NOW
  • 46. DATA for VALIDATION of Improvement actions : IMPROVE Process Without the use of color code by Use of color code by the porter the porter Patients Pre-Employment Patient Pre-Employment Sample SD – 6.7 SD- 7.05 SD- 4.66 SD- 5.92 Transport time Mean- 12.06 Mean- 10.24 Mean- 9.46 Mean- 9.95 RSD -55% RSD-68.84% RSD-49.2% RSD – 59.49% Work handled by the previous Work handled by the other phlebotomist phlebotomist w/ the appointment system Patients Pre-Employment Patients Pre-employment Sampling Time SD- 11.5 SD- 25.31 SD- 6.69 SD-8.0 Mean- 18 Mean – 33.35 Mean- 14.85 Mean 15.8 RSD- 63.8% RSD- 75.89% RSD- 45% RSD- 50.6%
  • 47. IMPROVE SIGNIFICANCE OF RESULTS: BEFORE AFTER DPMO = 18,272 DPMO = 2,554 SIGMA LEVEL: 3.59 SIGMA LEVEL: 4.3
  • 48. IMPROVE PRE-ANALYTICAL PROCESSES FOR PATIENTS Critical to Quality (CTQ): Delay in Pre-analytical Processes CTQ Measure: Number of delays occurred Defects: Delays PROCESS TURN- DPMO SIGMA DPMO SIGMA AROUND- Opportunity for LEVEL Opportunity for LEVEL TIME error:1 BEFORE error:1 AFTER (minutes) Time taken to 3 minutes Defects: 41 1.81 Defects: 11 2.76 complete process Units: 108 Units: 106 in reception DPMO: 379,630 DPMO: 103,774 Sampling Time 12 minutes Defects : 56 1.45 Defects : 26 1.59 Units: 108 Units: 56 DPMO: 518,519 DPMO: 464,286 Sample Transport 10 minutes Defects: 72 0.59 Defects:17 2.01 time Units: 88 Units: 56 DPMO: 818,182 DPMO: 303,571
  • 49. IMPROVE PRE-ANALYTICAL PROCESSES FOR PRE-EMPLOYMENT/ TRAINING/ VISA RENEWAL Critical to Quality (CTQ): Delay in Pre-analytical Processes CTQ Measure: Number of delays occurred Defects: Delay PROCESS TURN- DPMO SIGMA LEVEL DPMO SIGMA AROUND-TIME Opportunity for BEFORE Opportunity for LEVEL (minutes) error:1 error:1 AFTER Time taken to 3 minutes Defects: 126 1.48 Defects: 16 2.76 complete process Units: 249 Units:155 in reception DPMO: 506024 DPMO: 103,226 Sampling Time 12 minutes Defects : 199 0.66 Defects : 51 1.21 Units: 249 Units: 83 DPMO:799197 DPMO:614,458 Sample Transport 10 minutes Defects: 179 0.58 Defects: 34 1.73 time Units: 218 Units: 83 DPMO: 821101 DPMO: 409,638
  • 50. IMPROVE POST-ANALYTICAL PROCESSES FOR PATIENTS PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND-TIME Opportunity LEVEL Opportunity for error:1 AFTER (minutes) for error:1 BEFORE CBC Time taken from 5 minutes Defects: 28 1.15 Defects: PROCESS printed result to Units: 44 Units: ELIMINATED logbook registration DPMO: DPMO: 636,364 Time taken from 10 minutes Defects : 14 1.95 Defects : PROCESS logbook entry to IT Units: 43 Units: ELIMINATED entry DPMO: DPMO: 325,581 Time taken from 10 minutes Defects: 29 1.27 printing the result to Units: 49 IT entry DPMO: 591837 Time taken from IT 10 minutes Defects: 8 2.39 Defects: 9 2.4 entry to time of Units: 43 Units: 49 validation DPMO: DPMO: 186,047 183,673
  • 51. IMPROVE POST-ANALYTICAL PROCESSES FOR PATIENTS PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND-TIME Opportunity LEVEL Opportunity for error:1 AFTER (minutes) for error:1 BEFORE BIOCHEMISTRY Time taken from 15 minutes Defects : 37 1.53 Defects : 25 1.67 printing the result to Units: 76 Units: 58 IT entry DPMO: DPMO: 431034 486,842 Time taken from IT 10 minutes Defects: 21 2.09 Defects: 14 2.2 entry to time of Units: 76 Units: 58 validation DPMO: DPMO: 241379 276,316
  • 52. POST-ANALYTICAL PROCESSES FOR PRE- IMPROVE EMPLOYMENT/ TRAINING/ VISA RENEWAL Critical to Quality (CTQ): Delay in Post-analytical Processes CTQ Measure: Number of delays occurred Defects: Delay PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND- Opportunity for LEVEL Opportunity for AFTER TIME error:1 BEFORE error:1 (minutes) CBC Time from 5 minutes Defects : 111 0.7 Defects : PROCESS printed result to Units: 141 Units: ELIMINATED logbook DPMO: 787,234 DPMO: registration Time from enter 5 minutes Defects: 199 0.4 Defects: PROCESS result in logbook Units: 205 Units: ELIMINATED to enter it in DPMO: 970,732 DPMO: result form Time from printed 60 minutes Defects:1 3.81 result to IT Units:96 registration DPMO: 10417 Time from IT 60 minutes Defects:10 2.76 entry until result Units:96 validated DPMO: 104167
  • 53. POST-ANALYTICAL PROCESSES FOR PRE- IMPROVE EMPLOYMENT/ TRAINING/ VISA RENEWAL PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND- Opportunity for LEVEL Opportunity for AFTER TIME error:1 BEFORE error:1 (minutes) BIOCHEMISTRY Time from printed 5 minutes Defects : 107 0.4 Defects : PROCESS ELIMINATED result to logbook Units: 108 Units: registration DPMO: 990,741 DPMO: Time from logbook 5 minutes Defects: 201 0.4 Defects: PROCESS ELIMINATED entry to result Units: 204 Units: form entry DPMO: 985,294 DPMO: Time from result 60 minutes Defects: 248 0.4 Defects: PROCESS ELIMINATED from entry until Units: 248 Units: pathologist DPMO:985,294 DPMO: signature
  • 54. POST-ANALYTICAL PROCESSES FOR PRE- IMPROVE EMPLOYMENT/ TRAINING/ VISA RENEWAL PROCESS TURN- DPMO SIGMA DPMO SIGMA LEVEL AROUND- Opportunity for LEVEL Opportunity for AFTER TIME error:1 BEFORE error:1 (minutes) Time from result 60 minutes Defects: 248 0.4 Defects: PROCESS was signed until IT Units:248 Units: ELIMINATED* entry DPMO:985,294 DPMO: Time from printed 60 minutes Defects:10 2.72 result to IT Units:90 registration DPMO: 111111 Time from IT entry 60 minutes Defects: 248 0.4 Defects: 4 3.2 until result Units:248 Units:90 validated DPMO:985,294 DPMO: 44444 Time from 60 minutes Defects: 248 0.4 Defects: PROCESS ELIMINATED validation until Units:248 Units: logbook entry DPMO:985,294 DPMO: Time from logbook 60 minutes Defects: 248 0.4 Defects: PROCESS entry until result Units:248 Units: ELIMINATED release DPMO: 985,294 DPMO:
  • 55. IMPROVE The Goal statement: 1. Reduce the errors from 11% to 8% within 6 months. 2. Reduce delayed patients result from 45% to 30% within 6 months 3. Reduce delayed pre-employments and visa test results from 100% to 80%within 6 months. Achievement after IMPROVE 1. Errors reduced from 11% to 1.5% . 2. Delayed patients results reduced from 45% to 14% . 3. Delayed pre-employments and visa test results from 100% to 35%
  • 56. IMPROVE Before Expected After improve improve Errors 11% 8% 1.5% Patient 45% 30% 14.5% delayed results Pre-empl. 100% 80% 35% Delayed results
  • 57. IMPROVE Saved Cost: Unnecessary Requests • 5,512 tests / year Cost: 49,181 AED Rework • 1040 tests / year Cost: 9,279 AED Medical Laboratory Technician • 156 hours/ year wasted time to do the unnecessary requests, rework • Cost: 172,192 AED Office boy wasted time for delivery of Pre- • 52 hours/ year employment/Training results in the Medical Check Section • Cost: 6,171 AED TOTAL SAVINGS: 236,823 AED / YEAR
  • 58. CONTROL GUIDELINES, ASSINGNED RESPONSIPILITY, and COMMUNICATION:  Staff orientation on the New Standard Operating procedure  Daily check for IT performance  Check performance, scheduled calibration and PMs for barcode readers and photo-capturing devices.  Daily check for attendance of receptionists and porter  Monthly Control charts  Monthly reports to Champion  Review of Control charts and do corrective actions if required
  • 59. P Chart of Patients Sampling Time CONTROL 0.30 UCL=0.2720 0.25 0.20 Proportion 0.15 0.10 _ P=0.0894 0.05 0.00 LCL=0 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sampling Dates P Chart of Pre-employment Sampling Time 0.5 UCL=0.4401 0.4 0.3 Proportion _ 0.2 P=0.2123 0.1 0.0 LCL=0 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sampling Dates
  • 60. Xbar-R Chart of Patients Sampling Time CONTROL 14 U C L=14.018 13 Sample Mean _ _ 12 X=11.8 11 10 LC L=9.582 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s U C L=16.43 15.0 Sample Range 12.5 _ 10.0 R=9.94 7.5 5.0 LC L=3.45 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s Xbar-R Chart of Pre-Employment Sampling Time U C L=16.164 16 Sample Mean 15 _ _ X=14.444 14 13 LC L=12.725 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s U C L=12.74 12 Sample Range 10 _ 8 R=7.71 6 4 LC L=2.67 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s
  • 61. P Chart of Patients CBC Validation time CONTROL 0.35 UCL=0.3167 0.30 0.25 Proportion 0.20 0.15 _ 0.10 P=0.1024 0.05 0.00 LCL=0 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sampling Dates P Chart of Patients Biochemistry Validation 0.30 UCL=0.2910 0.25 0.20 Proportion 0.15 _ 0.10 P=0.0971 0.05 0.00 LCL=0 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sampling Dates
  • 62. Xbar-R Chart of Patients Biochemistry Validation Time CONTROL 8 U C L=8.111 7 Sample Mean _ _ 6 X=5.8 5 4 LC L=3.489 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s U C L=17.13 15 Sample Range _ 10 R=10.36 5 LC L=3.59 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s Xbar-R Chart of Patients CBC Validation Time 1 10 U C L=9.745 Sample Mean 8 _ _ 6 X=6.189 4 LC L=2.633 2 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s 1 30 U C L=26.35 Sample Range 20 _ R=15.94 10 LC L=5.52 6/11/2012 6/12/2012 6/13/2012 6/14/2012 6/18/2012 6/19/2012 Sa mpling Da te s
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